Healthcare system perceptions predict PSA screening uptake

By Ingrid Grasmo

Study findings suggest that African-American and Afro-Caribbean men who have poor perceptions or experiences of their healthcare system are less likely to have prostate-specific antigen (PSA) screening than those with positive healthcare experiences.

"Our results suggest that a broader discussion by physicians that addresses the perceptions regarding the healthcare system might enhance the understanding of, and increase the use of, prostate cancer screening among higher risk minority men," say Daniel Lee (Columbia University, New York, USA) and colleagues.

Lee and team administered a 6-item survey assessing perceived barriers within the healthcare system to 533 men aged 45-70 years who were from four different ethnic backgrounds (US-born White, US-born African American, Jamaican, or Trinidadian/Tobagonian).

Survey findings revealed that 25% of men had never received a screening recommendation and 40% did not have a discussion of their personal risk for prostate cancer with their physician. Overall, 27% of men had never had a PSA test, whereas 28% reported annual PSA screening.

White men reported significantly fewer healthcare system and self-efficacy barriers than African-American or Afro-Caribbean men. Importantly, men who reported having discussions with their physician about their family history of prostate cancer, personal risk for developing prostate cancer, and recommendations for prostate cancer screening reported significantly fewer perceived barriers.

Differences in perceived healthcare barriers were also related to PSA screening, with men who never received prostate cancer screening reporting significantly greater perceived barriers than those who had at least one PSA test or annual screening.

Multivariate analysis revealed that ethnic minority men were more likely to have initiated PSA screening but were less likely than White men to have maintained annual PSA screening.

Compared with men who had never had a PSA test, those who did not have a regular physician, had not undergone annual examinations, or had not had comprehensive physician discussions were 70%, 60%, and 60% less likely to ever have had a PSA test, respectively.

Men who found it difficult to receive reliable medical care were 40% less likely to ever have had a PSA test than those who reported easy access, while those who perceived the healthcare system as convenient were 1.8-fold more likely to initiate PSA screening.

"Perceived barriers and provider-level variables represent two factors that affect PSA screening behavior and are potentially modifiable," conclude the researchers in Urology.

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